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Feature Stories

Final APM Framework Released

Today’s release of the Alternative Payment Model (APM) Framework White Paper defines payment model categories and establishes a common framework and a set of conventions for measuring progress in the adoption of APMs, which are methods of rewarding health care providers based on the quality and coordination of the care they provide.

APMs are important mechanisms for delivering high-quality, cost-effective, person-centered health care. In the APM Framework, all payments to health care providers fall within one of four categories. Providers are encouraged to move to categories that offer greater quality and value. As they do so, they will experience increased accountability for both quality of care and total cost of care, with a greater focus on population health management (as opposed to payment for specific services).

“The White Paper marks an important milestone in the LAN’s progress to advance the adoption of new and innovative health care payment models that promise to improve the quality of health care for all Americans, while also reducing its cost,” said Sam R. Nussbaum, MD, chair of the LAN’s Alternative Payment Model Framework and Progress Tracking (APM FPT) Work Group, which developed the White Paper.

Join Today’s Webinar on the APM Framework White Paper

Please join us today from 12 – 1:30 pm ET for the public release of the final APM Framework White Paper. Don’t miss your chance to hear from APM Framework and Progress Tracking (APM FPT) Work Group Chair, Sam Nussbaum, and Guiding Committee Co-Chair, Mark McClellan, who will be presenting the final paper. The webinar will also feature presentations of case studies that exemplify categories in the APM Framework presented by Robert McConville from Intermountain Healthcare, Eileen Wood from Capital District Physicians’ Health Plan, Jeff Rideout from Integrated Healthcare Association, and John Pilotte from Centers for Medicare & Medicaid Services.

LAN Summit

Save the Date: April 25-26, 2016

Over 400 innovators gathered last fall to share best practices and collaborate on how to increase APM adoption. Plan to be part of the conversation April 25-26 at the spring LAN Summit in Tysons Corner, Virginia. Share your experiences, get your questions answered, and learn about new models being implemented across the country and how these experiences can help shape your own successful adoption of APMs. Stay tuned for registration information. A call for abstracts will also open soon.

Leadership Corner

Members Look Ahead to Priorities in 2016

In its first virtual meeting of 2016, the LAN Guiding Committee (GC) discussed options to advance performance measurement initiatives in order to accelerate the adoption of APMs across multiple stakeholders and settings of care. Discussion centered around what is the most appropriate role for the LAN is in the area of performance measurement, specifically related to measures for APM categories 3 and 4, in addition to what it is already tackling in the Population-Based and Clinical Episode Payment Work Groups. To help frame the discussion, the LAN staff met with several external experts to consider what the short-term opportunities are, and highlighted this issue for further discussion. GC members participated in an exercise to elicit input and recommendations on how to incorporate performance measurement work in the LAN and generated ideas. Highlights included a focus on regional and state measurement efforts, and how the LAN could learn from some key regions and states that are already testing and implementing next generation measures, as well as the importance of patient-centered outcomes, total cost of care, and clinical outcome measures. GC members discussed potential partners and emphasized the need for caution to avoid moving too quickly. The GC also announced a new member, Tom Betlach, Director of the Arizona Health Care Cost Containment System, who is joining the committee this month.

LAN Progress

Coming Soon: Draft White Paper on Patient Attribution

The Population-Based Payment (PBP) Work Group is developing its first draft white paper. The topic is “patient attribution,” the method by which patient populations are assigned to providers who are accountable for total cost of care and quality outcomes for their designated populations in a PBP model. Efforts to address patient attribution were launched at the November 5, 2015 in-person meeting of the PBP Work Group. The work group plans to complete the draft paper this month, open a comment period in early February, and release the final paper in April. The paper will include a set of high-level “consensus guidelines” based on the work group’s recommendations for patient attribution in PBP models, as well as feedback from LAN participants.

Clinical Episode Payment Work Group Tackles Quality

On January 5, 2016, the Clinical Episode Payment (CEP) Work Group met virtually to continue developing a set of recommendations for facilitating adoption of joint replacement episode payment. The CEP Work Group engaged in an informative discussion on a number of issues related to the use of quality metrics in episode payment, including 1) the criteria for selecting core measures that will reflect provider performance and potentially affect reimbursement; 2) how quality metrics should be used to communicate information to consumers and patients; and 3) the need to risk adjust measures to reflect patient case mix. In addition, the work group discussed the issues and challenges related to building an effective infrastructure for data collection, analysis, and payment.

The discussion yielded useful information about the current state of data systems for bundled payments, which the work group felt is currently inadequate to provide actionable data to providers, payers, consumers, and patients. Work group members provided a wide array of suggestions and recommendations on how data can be collected, stored, analyzed, and shared. The work group’s ultimate goal is to create a white paper that identifies elements of episode design that may be common across multiple conditions or procedures, and put forward recommendations for those elements. The paper will also describe options related to data systems and analysis which are foundational to the implementation of bundled payments.

LAN News

Join Work Group Affiliated Communities

If you’re interested in learning more about patient attribution or financial benchmarking in a PBP model, join the PBP affiliated community in Handshake to weigh in on questions posed by the work group. If you’re interested in elective hip and knee replacement, maternity, or cardiac care bundled payments, join the CEP affiliated community to weigh in on questions posed by this work group. We look forward to your thoughtful input. If you would like to join Handshake for the first time, request an invitation at PaymentNetwork@MITRE.org

In our latest blog, Senior Vice President for Global Benefits at Wal-mart Stores, Inc and member of the LAN Guiding Committee, Sally Welborn emphasizes the role of employers in realigning our country’s health care payment paradigm. The blog states that company business models cannot sustain cost increases in general and administrative expenses (which is where most employers pay for employee benefits) that exceed increases in income streams. She highlights the need to control the ever increasing spiral of health care costs impacting both companies and their employees while improving the quality of care and outcomes.

The LAN is in the early stages of creating a Payer Collaborative in an effort to measure adoption of APMs nationwide. This collaborative will serve as a means for the LAN to appropriately measure progress of APM adoption rates against the LAN’s goals of 30 percent adoption by 2016 and 50 percent adoption by 2018. The purpose of the collaborative is to gather feedback on the metrics proposed in the APM Framework White Paper and to test the feasibility of the proposed survey instrument. The collaborative will also help inform a longer term measurement effort by the LAN of APM adoption by commercial, Medicaid, and Medicare Advantage health plans. With input from a group of industry leaders of both public and private health plans in the collaborative, the LAN will be able to set its course towards proper and consistent measurement of APM adoption rate metrics.

To achieve the goal of better care, smarter spending, and healthier people, the U.S. health care system must substantially reform its payment structure to incentivize quality, health outcomes, and value over volume. The Health Care Payment Learning and Action Network (LAN) was established as a collaborative network of public and private stakeholders, including health plans, providers, patients, employers, consumers, states, federal agencies, and other partners within the health care community.